简介:目前的指南推荐使用胰高血糖素样肽-1受体激动剂(GLP-1RAs)治疗代谢功能障碍相关的脂肪变性肝病(MASLD),尤其是糖尿病和肥胖并存的患者。这项研究调查了GLP-1RAs对MASLD患者肝脂肪变性和纤维化的影响。根据实际临床环境中振动控制的瞬时弹性成像(VCTE)和其他临床参数的变化进行测量。方法:我们进行了单中心,回顾性分析来自多学科护理诊所的96例MASLD患者,这些患者在基线和随访6-24个月内完成了VCTE,以比较受控衰减参数(CAP)和肝硬度测量(LSM)的变化,以及其他代谢标志物,使用双样本t检验和Wilcoxon秩和检验在GLP-1RA使用者和非使用者之间进行比较。我们还评估了肝脏脂肪变性的改善,定义为CAP的变化>38dB/m,如先前文献中所述,与纤维化的改善有关。结果:使用GLP-1RA可显著改善体重(-8.1kgvs.-3.5kg,P=0.009),体重指数(BMI)(-2.9kg/m2vs.-1.3kg/m2,P=0.012),丙氨酸氨基转移酶(-15.0IU/Lvs.-4.0IU/L,P=0.017),天冬氨酸氨基转移酶(-5.0IU/Lvs.-1.0IU/L,P=0.021),糖化血红蛋白(HbA1c)(-0.7%vs.0.1%,P=0.019),和CAP(-59.9dB/mvs.-29.1dB/m,P=0.016)。响应者的体重也有显着改善(-9.2kgvs.-1.9kg,P<0.001),BMI(-3.3kg/m2vs.-0.7kg/m2,P<0.001),舒张压(-6.1mmHgvs.-0.7mmHg,P=0.028),HbA1c(-0.8%vs.0.3%,P<0.001),和LSM(-1.5kPavs.0.1kPa,P<0.001)。结论:使用GLP-1RAs治疗的MASLD患者显示出肝脂肪变性和多种其他代谢参数的显着改善,体重减轻是这种肝脏改善的机制。此外,CAP>38dB/m的变化与LSM和其他代谢参数的改善有关,提示VCTE在MASLD监测中的临床应用。
Introduction: Current guidelines recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD), especially in patients with comorbid diabetes and obesity. This study investigated the effects of GLP-1RAs on hepatic steatosis and fibrosis in patients with MASLD, as measured by changes in vibration-controlled transient elastography (VCTE) and other clinical parameters in a real-world clinical setting. Methods: We conducted a single-center, retrospective analysis of 96 patients with MASLD from a multidisciplinary care clinic who completed VCTE at baseline and follow-up within 6-24 months to compare changes in controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as well as other metabolic markers, between GLP-1RA users and nonusers using two-sample t-tests and Wilcoxon rank-sum tests. We also assessed whether improvements in hepatic steatosis, defined as a change in CAP >38 dB/m as previously described in the literature, were associated with improvement in fibrosis. Results: GLP-1RA use resulted in significant improvements in weight (-8.1 kg vs. -3.5 kg, P = 0.009), body mass index (BMI) (-2.9 kg/m2 vs. -1.3 kg/m2, P = 0.012), alanine aminotransferase (-15.0 IU/L vs. -4.0 IU/L, P = 0.017), aspartate aminotransferase (-5.0 IU/L vs. -1.0 IU/L, P = 0.021), glycated hemoglobin (HbA1c) (-0.7% vs. 0.1%, P = 0.019), and CAP (-59.9 dB/m vs. -29.1 dB/m, P = 0.016). Responders also had significant improvements in weight (-9.2 kg vs. -1.9 kg, P < 0.001), BMI (-3.3 kg/m2 vs. -0.7 kg/m2, P < 0.001), diastolic blood pressure (-6.1 mmHg vs. -0.7 mmHg, P = 0.028), HbA1c (-0.8% vs. 0.3%, P < 0.001), and LSM (-1.5 kPa vs. 0.1 kPa, P < 0.001). Conclusions: Patients with MASLD treated with GLP-1RAs showed significant improvements in hepatic steatosis and multiple other metabolic parameters, with weight loss as the proposed mechanism for this liver improvement. In addition, change in CAP >38 dB/m was associated with improvements in LSM and other metabolic parameters, suggesting the clinical utility of VCTE in the surveillance of MASLD.